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中华脑科疾病与康复杂志(电子版)

中华脑科疾病与康复杂志(电子版) ›› 2020, Vol. 10 ›› Issue (03) : 178 -182. doi: 10.3877/cma.j.issn.2095-123X.2020.03.011

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综述

责任血管与三叉神经痛显微血管减压术的关系
李强1, 于炎冰1, 杨文强1, 李锐1, 张黎1,†()   
  1. 1. 100029　北京，中日友好医院神经外科
  • 收稿日期:2020-04-01 出版日期:2020-06-15
  • 通信作者: 张黎

Relationship between offending vessels and microvascular decompression for trigeminal neuralgia

Qiang Li1, Yanbing Yu1, Wenqiang Yang1, Rui Li1, Li Zhang1,†()   

  1. 1. Department of Neurosurgery, China-Japan Friendship Hospital, Beijing 100029, China
  • Received:2020-04-01 Published:2020-06-15
  • Corresponding author: Li Zhang
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李强, 于炎冰, 杨文强, 李锐, 张黎. 责任血管与三叉神经痛显微血管减压术的关系[J]. 中华脑科疾病与康复杂志(电子版), 2020, 10(03): 178-182.

Qiang Li, Yanbing Yu, Wenqiang Yang, Rui Li, Li Zhang. Relationship between offending vessels and microvascular decompression for trigeminal neuralgia[J]. Chinese Journal of Brain Diseases and Rehabilitation(Electronic Edition), 2020, 10(03): 178-182.

三叉神经痛（TN）常表现为单侧反复发作性电击样疼痛，其疼痛范围严格限制在三叉神经感觉根分布的范围内，其重要病因是责任血管对三叉神经感觉根的压迫，最常见的类型为经典型TN（CTN）。神经血管压迫（NVC）的位置可发生于颅内桥小脑角区（CPA）三叉神经感觉根的任何部位，而出脑干区（REZ）是最常见的压迫位置。造成压迫的责任血管的类型不一。三叉神经感觉根长轴与身体长轴的夹角度数、REZ长度、神经纤维发生的扭曲旋转及不同的责任血管压迫位置都可能会影响TN疼痛的范围。显微血管减压术（MVD）是CTN患者最有效的外科治疗方法，具有很高的治愈率和较少的并发症，但术后无效和复发仍占有一定比率，术中准确判断责任血管压迫位置并充分减压是术后疼痛有效缓解的重要保证，但是其中高达30%的细微压迫不能被发现，多重血管压迫也并不少见。NVC位置与责任血管类型是影响TN疼痛范围的主要因素，对NVC位置进行区域划分并进一步研究不同NVC位置中责任血管类型对TN疼痛范围的影响，为提高MVD治疗CTN的成功率提供理论依据。

关键词: 三叉神经痛, 显微血管减压术, 神经血管压迫, 责任血管

Trigeminal neuralgia (TN) is usually characterized by unilateral recurrent electric shock-like pain, and its painful range is strictly limited to the distribution of the branches from trigeminal sensory root, its etiology is neurovascular conflict (NVC) of the trigeminal sensory root, classic trigeminal neuralgia (CTN) is the most common type. The location of NVC can occur in any part of the trigeminal sensory root, and root entry zone (REZ) of the trigeminal sensory root is the most common position of NVC. The types and proportions of offending vessels are different. The angle between the long axis of trigeminal nerve root and the long axis of body, the length of REZ area, the rotation of trigeminal sensory fiber and the different compression position of trigeminal nerve sensory root can affect the painful range of TN. Microvascular decompression (MVD) is the most effective surgical treatment for CTN patients, with high cure rate and few complications, but there are still a certain proportion of ineffective and recurrence after operation. Accurate judgment of NVC position, complete release of offending vessels and adequate decompression are the important guarantee of postoperative relief rate effectively. However, up to 30% of slim compression cannot be found, and multiple vascular compression occasionally occurs. The location of NVC and the proportion of offending vessels are the main factors affecting the painful range of TN. Further studies which are divisions of locations from NVC and influences of types from offending vessels in different positions on the painful range of TN, will provide theoretical basis for improving the success rate while patients with CTN have MVD surgery.

Key words: Trigeminal neuralgia, Microvascular decompression, Neurovascular conflict, Proportion of offending vessels
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